Health Select Committee Inquiry into Suicide Prevention
Written evidence from the Independent Mental Health Services Alliance (IMHSA)
The Independent Mental Health Services Alliance (IMHSA) welcomes a whole system approach to suicide prevention.
Independent providers of mental health services play an important role in the sector. This should be recognised where possible at a local and national level to ensure efforts to prevent suicides are collaborative and effective.
IMHSA believes there are several barriers in the current commissioning and funding system that restrict patient access to vital mental healthcare. These barriers are creating delayed discharges and driving up waiting times, which undermine mental healthcare providers’ ability to prevent suicides amongst vulnerable people.
It is essential that these barriers are addressed in order to ensure patients access the care they need in a timely manner and to prevent tragic outcomes that can occur when people cannot access appropriate care. IMHSA members wish to work with the NHS to tackle these issues and improve patient outcomes and access to care.
IMHSA’s members work hard to provide local, high-quality and cost-effective services to patients in need of mental healthcare, often at crisis point. Our focus is ensuring that patients are able to access a timely, tailored pathway of care and support that enables positive patient outcomes.
IMHSA is committed to working in partnership with all stakeholders to improve patient outcomes and access to care. For example, the independent sector recognises the need for more data transparency across the mental health sector, and already provides a significant amount of data that is not being used as effectively as possible to improve access to care. A joined-up approach to suicide prevention is vital, and therefore the sector is keen to work with the NHS to provide the information required and in the most helpful format.
However, there are barriers in the system (outlined below) that limit patient outcomes and access to care. We believe these must be addressed in order to enable patients to receive the care they need and prevent tragic incidents from occurring.
If these barriers are addressed, it will allow services to be developed where they are needed (including those that focus on prevention), in order to ensure patients are able to access the timely, quality care they need.
Commissioning barriers to patient access to appropriate care
IMHSA believes patient access to essential care is being limited by the lack of available capacity in the system to meet the high, and increasing, demand for mental health services. This is a result of inefficient commissioning practices and barriers in the system, which hinder innovation, increase waiting times and drive up the costs of care.
Longer waiting times put mental health patients at risk; surveys have shown that the majority of patients feel more mentally unwell while on waiting lists for treatment. As such, IMHSA believes that NHS England must introduce waiting time access standards for all mental health inpatient services. This will help to ensure patients receive the level of care they need, when they need it, so that their acuity of need does not grow and place them at increased risk of self-harm.
IMHSA has consistently called for NHS England to introduce a legal requirement that urgent referrals for admission are fully funded, without regard to any centrally imposed moratorium on new beds. This is crucial if we are to ensure critically ill mental health patients receive the right care, at the right time, to prevent them reaching crisis point.
The continued use of unaccountable block contracts is negatively impacting patient access to mental healthcare. These limit transparency and patient choice of services; the commissioning of an unaccountable block contract, which is poorly monitored and defined, means that other providers are not able to offer services to that patient population – even if they can provide a service more suited to local patient demand.
Analysis conducted by IMHSA has shown that block contracts are a contributing factor to delayed patient discharges. In 2014/15, delayed discharges were a third higher in mental health trusts with 100 per cent block contracts, than those trusts providing mental health services without a block contract.
NHS England has previously stated that unaccountable block contracts should be phased out for mental health, and we welcome the statements to that effect in the recently published proposals for the 2017/18 and 2018/19 National Tariff. This was also an issue highlighted by the independent Mental Health Taskforce’s final report. It is essential that this aim is realised as soon as possible in order to improve service commissioning and ensure that patients are able to receive the care they need, when they need it. This will help to improve patient outcomes.
Patient access to mental healthcare also suffers from the commissioning divide between NHS England and CCGs. At present, specialised inpatient services are commissioned by NHS England, while CCGs commission non-specialised services and community care. This means that patients have to move through different commissioning budgets to step-down from inpatient services. IMHSA members have found that blockages can be created when specialised service commissioners and CCGs have to negotiate as to what setting is most appropriate for a patient and who should be funding this.
This leads to delayed discharges as patients are prevented from stepping-down, which in turn increases waiting times for other patients who are in need of specialised care. IMHSA is calling for a clearer commissioning system with well-defined responsibilities for CCGs and NHS England. This would help to improve patient access to appropriate services and ensure they are receiving the right support to achieve positive outcomes.
IMHSA believes there is an opportunity to address some of these commissioning barriers as part of the multi-agency suicide prevention plans that each area must have in place for annual renewal by 2017. In February 2016, NHS England’s response to the independent Mental Health Taskforce’s final report made clear that these must be in place in order to meet its aim of reducing suicides by 10 per cent by 2020. In order for these plans to be effective, and for barriers to be overcome, it is crucial that independent sector providers of mental health services, where possible, are involved in the shaping of these plans. This is essential to ensuring a joined-up approach to crisis care in local health economies.
Mental health has historically suffered from significant disinvestment. Although the government has announced funding boosts to certain service areas, these wider issues have been consistently exacerbated by the National Tariff. Previous tariff deflations, and this year’s tariff uplift, have been linked inappropriately to local price setting for mental health services, failing to take into account the different cost base for mental healthcare.
IMHSA is calling for new guidance that more accurately reflects the costs associated with mental healthcare and ensures that the funding received is sufficient to meet patient demand and local service needs. This will help to ensure patients can access appropriate services and will not have to join long waiting lists or only be able to access services that are not tailored to their needs.
Ultimately these barriers, and the others noted above, must be addressed in order to prevent suicides. Otherwise, people in crisis will be unable to access services when they need them.
Similarly, long waiting lists and poor access to appropriate services will increase patient needs. The independent sector can play a significant role in providing patients with the high quality care and support they need, but these barriers must be addressed to ensure that all patients can access this.
About the Independent Mental Health Services Alliance (IMHSA)
The Independent Mental Health Services Alliance (IMHSA) is a group of leading independent providers of mental health services.
IMHSA’s members deliver a wide range of high-quality services to adults, children and young people with mental health difficulties. The independent sector works hard to ensure that patients are able to access a timely, tailored pathway of care and support.
IMHSA is committed to working in partnership with all stakeholders to improve patient care and ensure that all patients are able to access quality mental health services when they need them.